What is PseudoBalbar Affect?

From the desk of Melanie Whetzel, M.A., CBIS, Lead Consultant – Cognitive/Neurological Team

PseudoBulbar Affect (PBA) is a neurological condition that causes uncontrollable outbursts of crying or laughing. If you break the term down literally, “pseudo” means false, “bulbar” refers to the brainstem, and “affect” describes how the body shows mood or emotion. PBA can occur when certain neurologic diseases or brain injuries damage the areas in the brain that control normal expression of emotion. This damage can disrupt brain signaling, causing a “short circuit” and triggering involuntary episodes of crying or laughing. Conditions that can cause PBA include traumatic as well as acquired brain injuries (such as a stroke), Alzheimer’s disease and other types of dementia, multiple sclerosis (MS), Parkinson’s disease, and amyotrophic lateral sclerosis (ALS). PBA is not a new condition. It was first described in medical literature over 130 years ago by Charles Darwin.

About PBA:

PBA episodes can be described in two key ways: inappropriate and exaggerated.

Inappropriate: One characteristic of PBA episodes is that the crying or laughing episodes are inappropriate to the situation in which they occur. Sometimes the spontaneous outbreak of crying or laughing does not mirror the way a person is actually feeling.

Exaggerated: Another characteristic of PBA episodes is that though the crying or laughing may be appropriate for the situation, the emotions are exaggerated – they’re more intense or last longer than the situation calls for.

PBA is different from depression, though it is often mistaken for it. Many individuals may have both conditions. It is important that each condition be diagnosed and treated separately. Generally speaking, depression is an ongoing and continuous state of sadness or hopelessness that can last for weeks, months, or even more long term. PBA episodes are relatively brief, spontaneous eruptions that may not truly reflect what a person is feeling inside, or at least to the extent that it appears.

Accommodation Ideas for PBA:

Stress may exacerbate the symptoms of individuals with PBA. For this reason, employers may want to consider accommodations to help reduce and/or remove stressors in the work environment. Not everyone with PBA may need accommodations to perform their jobs and others may only need a few. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.

Stress / Emotions:

Encourage use of stress management techniques to deal with frustration

Allow the presence of a support animal

Allow telephone calls during work hours to doctors and others for needed support

Use a mentor or supervisor to alert the employee when his/her behavior is becoming unprofessional or inappropriate

Assign a supervisor, manager, or mentor to answer the employee's questions

Restructure job to include only essential functions during times of stress

Refer to counseling, employee assistance programs (EAP)

Provide backup coverage for when the employee needs to take breaks

Allow flexible work environment:

Flexible scheduling

Modified break schedule

Leave for counseling

Work from home/Flexi-place

Situations and Solutions:

Read the following real-life examples of individuals with PBA in the workplace:

Situation:A court employee was having difficulty with emotions after returning to work following a TBI. She was diagnosed with PBA where she would have outbursts of uncontrollable laughter at seemingly inappropriate times.

Solution:The employee asked that her co-workers be educated on PBA so they would better understand what could be viewed as inappropriate laughter. She was also accommodated with extra breaks to help manage her stress, a temporary lightening of her workload, and a flexible schedule to allow her time for counseling and doctor appointments.

Situation: An engineer/project manager returned to work after a twelve week leave that helped him recover from a stroke. He was having difficulty with sudden bouts of crying in front of others at improper times. His manager spoke to him about it and the resulting awkward team interactions.

Solution: The employee requested leave under the ADA to seek a medical diagnosis and treatment. Telework was also discussed as an accommodation that could assist him until he could get his condition under better control.

Tips for Living with PBA

Be open about it. Let people know that you cannot always control your emotions because of a neurologic condition. This can help ensure that people are not surprised, confused or insulted.

Distract yourself. If you feel an episode coming on, try to focus on something unrelated.

Breathe. Take slow deep breaths until you are in control.

Relax. Release the tension in your forehead, shoulders, and other muscle groups that tense up during a PBA episode.

Change your body positions. Note the posture you take when having an episode. When you think you are about to cry or laugh, change your position.

These tips are general coping techniques. Consult with your doctor for medical advice and additional ways to manage PBA symptoms when episodes occur and guidance about whether a treatment plan may be appropriate. Please feel free to contact JAN if you seek assistance in coping with PBA in the workplace.